Complex PTSD is not currently an official diagnosis within the DSM-5, despite having long been recognized as a presenting problem by many psychologists. Also referred to as developmental trauma, C-PTSD is the result of traumas that occur over a long period of time. Causes include multiple incidents of child abuse, prolonged childhood neglect, prolonged domestic violence, and other instances of sustained or repetitive trauma.
C-PTSD is very frequently diagnosed as borderline personality disorder, bipolar disorder, ADHD, and other things, often depending (unfortunately) on the age and gender of the person being diagnosed. Because the trauma occurs most frequently during childhood, while the brain and body are rapidly developing, prolonged trauma at a young age has a profound effect on several areas of psychological development, as well as on the body. It affects attention, memory, emotional regulation, ideas about other people, core beliefs about relationships and about personal autonomy and safety, and considerably more.
- interpersonal problems, including detachment, distance, difficulty accepting comfort, love, or praise, and/or overattachment and social preoccupation
- interpersonal sensitivity: being easily hurt and/or prone to explosions of anger and rage
- difficulty with self-perception: identity confusion, feelings of worthlessness, feelings of being unreal or that one’s identity is dependent on others
- dissociation: disconnecting from reality, anywhere from daydreaming or “spacing out” to feeling entirely disconnected from one’s body or emotional processes
- emotional dysregulation: intensely felt and expressed emotions (often labeled by others as “overreacting” or “dramatic”), rapid and intense swings of emotion, emotional suppression leading to feelings of numbness and emptiness, unexpressed anger leading to risky or self-harming behaviors
- persistent sense of threat: being hypervigilant to cues, easily startled
- avoidance of reminders of the traumas
- flashbacks, nightmares, and/or intrusive thoughts about the traumas
- I treat C-PTSD with a relational approach that often includes DBT Skills Training as an added help in establishing emotional regulation and interpersonal abilities. The ISTSS recommends a three-phase treatment:
Phase 1 focuses on improving safety, reducing symptoms and skills training, which increases the person’s emotional, social and psychological competencies. Improving safety refers to reducing unsafe behaviors, e.g. self harm, and risk taking, and if possible establishing a safe environment at home. Phase 1 also focuses on building trust in the therapeutic relationship and creating a foundation for future work together.
Phase 2 focuses on processing and reappraisal of the unresolved trauma memories. This results in memories being integrated into an “adaptive representation of self, relationships and the world.”
Phase 3 involves consolidating treatment gains, and using them to build a life that is interpersonally connected, functional at work/school, and rich in personal meaning.